Last week in the pulmonology clinic, one of the physicians called out to me down the hallway. He said he needed his annual PPD placed and I was going to be the one to do it. So he gathered the supplies – a vial of tuberculin and two needles – and we headed into an exam room.
First, the attending demonstrated how to place a PPD on me. He cleaned the spot on my forearm, cleaned the top of the tuberculin vial, drew up 0.1 mL of tuberculin, pulled my skin taut and injected the tuberculin intradermally.
It was weird for me to carefully watch this whole process because I usually look the other way during injections and blood draws. I’ve had a pretty strong fear of needles since I was a kid, but over the past few years of medical school it has gotten way better. I watched the needle go in and watched a large bleb form under the skin and it didn’t really bother me. After blotting away a drop of blood and putting on a bandage, it was my turn to place the PPD.
The last time I wielded a needle with a real person was during the summer. I performed two blood draws with a phlebotomist at the family practice where I did my family medicine rotation. Both of those went well, but I was certainly helped along by the phlebotomist’s expert eye for the best veins. Before that, we all had to practice inserting IVs on each other during our third year orientation. That went pretty well too, although I had never had an IV before and it was surprising how much it hurt! Other than that, my only needle work has been with a practice mannequin in the simulation center. It was a little intimidating to be practicing my intradermal injection skills on my attending, but it turned out fine. I copied his technique, keeping a low angle during the needle insertion and slowly injecting the tuberculin to raise a bleb. He didn’t even bleed or need a bandage! I was pretty pleased with my work.
This was a perfect example of the educational philosophy “see one, do one, teach one.” I watched my attending place a PPD, I successfully placed one myself and now I feel like I could teach someone else to perform the procedure. It may not be so simple for more complicated procedures, but for a relatively minor procedure, it was a great way to learn. It was exciting to learn more actively for a change, since sometimes third year can feel like an extended shadowing experience. And the next time the chance to do a procedure is offered, I’ll know I’ll be a bit more confident as I jump in!